This study aims to assess the efficacy of narrow-band ultraviolet B (NB-UVB) phototherapy as a standalone treatment in patients with resistant and recurrent tinea.

To evaluate the clinical and mycological improvement in response to NB-UVB therapy compared to standard anti-fungal treatment alone.

Randomized, parallel-group, two-arm clinical trial. Arm A (NB-UVB group): Patients receive narrowband UVB phototherapy only.

Arm B (Itraconazole + Terbinafine group): Patients receive combined oral itraconazole and terbinafine.

Allocation will be 1:1 using concealed randomization.

Intervention:

Intervention (Arm A):

Patients in Arm A will receive narrowband UVB phototherapy (311 nm) three times per week for a total of 8 weeks.

Starting dose: 280-320 mJ/cm² (based on Fitzpatrick skin type)

Dose escalation: Increase by 10-20% each week as tolerated, with weekly monitoring for erythema or other adverse effects.

Follow-up: All Arm A patients will be re-evaluated clinically and mycologically 8 weeks after completing the 8-week NB-UVB course (i.e., at week 16 from baseline) to assess sustained response and relapse.

Intervention (Arm B):

Patients in Arm B will receive oral itraconazole plus terbinafine concurrently:

Itraconazole: 200 mg once daily for 8 weeks

Terbinafine: 250 mg once daily for 8 weeks

Follow-up: All Arm B patients will be re-evaluated clinically and mycologically 8 weeks after completing the 8-week antifungal course (also at week 16 from baseline) to assess sustained response and relapse.

Monitoring: Weekly observation for erythema or side effects.

A follow-up period of 8 weeks after the end of treatment will be included to assess relapse and sustained clinical/mycological improvement.

Inclusion Criteria:

• Adults aged ≥18 years.

Both sexes.

Clinical diagnosis of tinea corporis or cruris.

Failure of ≥4 weeks of systemic antifungal therapy (e.g., terbinafine or itraconazole).

No antifungal (topical or systemic) or corticosteroid treatment in the 2 weeks preceding enrollment.

Recurrent infection (≥2 relapses in the past 6 months)

Positive KOH microscopy and culture at baseline

Exclusion Criteria:

• Photosensitivity disorders or photosensitizing medications.

Xeroderma pigmentosa, LE or other photosensitive dermatoses. dermatomyositis.

Other skin conditions (psoriasis, eczema, etc.).

Known autoimmune diseases, immunosuppression, or coagulopathies..